In this episode, I’ll discuss what predicts critical care pharmacist intervention – patient acuity or medication regimen complexity?
It makes intuitive sense that both scenarios of high patient acuity and high medication regimen complexity would be legitimate ways of identifying ICU patients who are more likely to need pharmacist intervention.
I’ve always liked starting my day in the ICU by talking with the charge nurse about the patients who appear the sickest. Admittedly, this does not necessarily indicate who requires an intervention, nor does it always lead towards evaluating the patient who most needs pharmacy services first.
Researchers published in AJHP a post-hoc analysis of an already completed prospective observation trial to compare the relationship of medication regimen complexity versus a traditional patient acuity metric for evaluating pharmacist interventions.
The data the analysis was performed on was 100 patients, split evenly between medical and surgical reasons for admission.
The primary outcome was the relationship between medication regimen complexity, defined by the medication regimen complexity–intensive care unit (MRC-ICU) score, and acuity, defined by the Acute Physiology and Chronic Health Evaluation (APACHE) II score, and pharmacist interventions at 24 hours, 48 hours, and ICU discharge.
Both metrics were correlated to pharmacist intervention in the raw dataset at all 3 timepoints studied – 24 hrs post ICU admission, 48 hrs post, and at ICU discharge. However, when adjusting for patient age, gender, and admission type, only the MRC-ICU score was associated with pharmacist intervention at each time point.
The study is limited by its post hoc design; however, it suggests that medication regimen complexity could be a useful way to identify patients in need of a critical care pharmacist intervention. Because the MRC-ICU score is calculated based on medication names and classes, the scoring system could be built into an electronic health record or report to help critical care pharmacists better prioritize their day.
To access my free download area with 20 different resources to help you in your practice, go to pharmacyjoe.com/free.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
Leave a Reply